Background. Kinematic MRI of the Lumbar Spine The UMMC Experience. Background. Background

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1 Kinematic MRI of the Lumbar Spine The Experience DR TOK CHUNG HONG SENIOR LECTURER DEPARTMENT OF BIOMEDICAL IMAGING FACULTY OF MEDICINE UNIVERSITY OF MALAYA Magnetic resonance imaging provides excellent anatomic detail of spinal tissues, but fails to provide the type of information that permits a definitive diagnosis in many patients with back pain. Background Dynamic Myelogram Prone Lateral Prone with needle in situ Prone centre at L4/L5 Prone centre at L5/S1 LAO RAO Background Lateral Lying Lateral Standing Lateral Flexion Lateral Extension AP Standing Flexion to L AP Standing Flexion to R Background New imaging strategies that can be applied to the study of intervertebral disc degeneration include diffusion weighted imaging (DWI) magnetic resonance imaging, diffusion tensor imaging, magnetic resonance spectroscopy, functional magnetic resonance imaging, dynamic computed tomography and magnetic resonance imaging, and T2 relaxometry.

2 Axial loaded MRI of the lumbar spine Neutral position Change in lumbar lordosis Axial loaded Images Neutral position Axial loaded Image Axial loaded Image Neutral position Axial loaded Images Reduced spinal canal diameter Narrowing of the lateral recesses Presence of the occult facet ganglion/cyst

3 Definition It is natural to begin this discussion by considering the various possible types of motion in themselves, leaving out of account for a time the causes to which the initiation of motion may be ascribed; this preliminary enquiry constitutes the science of Kinematics. ET Whittaker Effectiveness Of Kinematic And High Resolution CISS Sequence Of Magnetic Resonance Imaging In Evaluation Of Lumbar Spondylosis Effectiveness of Kinematic and high resolution CISS sequence of MRI in evaluation of lumbar spondylosis OBJECTIVES: To assess the added value of Kinematic Magnetic Resonance Imaging (full extension, full flexion and especially the lateral flexion positioning in comparison to recumbent or neutral MRI imaging in lumbar spondylosis). To assess the value of CISS (constructive interference in steady state) sequence of MRI imaging in lumbar spondylosis. To assess correlation between kinematic MRI and clinical symptoms in comparison to conventional MRI imaging. Effectiveness of Kinematic and high resolution CISS sequence of MRI in evaluation of lumbar spondylosis With the advent of open configuration MRI systems, dynamic or kinematic studies allow evaluation of physiological as well as pathological changes in the relationships of the intervertebral disc, the spinal canal, and the neural foramina as well as the assessment of segmental instability in physiologic body positions. CISS (constructive interference in steady state) sequence Provides better spatial and contrast resolution particularly in the imaging of nerve roots and neural foramina morphology. Neutral supine position

4 Right bending position Left bending position Lateral flexion position Lateral extension position Right bending Left bending Lateral extension Lateral flexion

5 Drawback / Limitation Induced pain Time consuming Normal sequence : about 30 min Kinematic sequence : additional 45 min Remedy action > analgesia prior to procedure

6 Conclusion Weishupt D et al; Positional MR imaging of the lumbar spine proved that positional MR imaging more frequently demonstrates minor neural compromise than does conventional MR imaging. It also concluded that positional pain differences are related to position dependent changes in foraminal size. Saifuddin A et al; Axial loaded MRI of the lumbar spine; concluded in the erect extension position, or with axial compression can identify occult nerve root compression not identified on conventional supine imaging Conclusion Ramli N et al concluded that CISS imaging provides superior topographical information regarding extradural and intradural pathology. It also has the advantages of imaging nerve and neural tethering in fine detail; as well as delineating structural abnormalities of nerve root compression. With kinematics (dynamic / positioning) imaging, the relative motions of normal and degenerated lumbar motion segments can be evaluated noninvasively and provide the clinicians better diagnosis and outcome. Thank you for your attention

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